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Are digital medical records good for your health?

March 17, 2010

The federal government is betting billions that electronic medical records can save even bigger amounts by cutting down on paperwork and unnecessary care. Some reformers also claim electronic records can actually make us healthier. Is that true? WHYY asked the experts.

The federal government is betting billions that electronic medical records can save even bigger amounts by cutting down on paperwork and unnecessary care. Some reformers also claim electronic records can actually make us healthier. Is that true? WHYY asked the experts.

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Two years ago, Jefferson Family Medicine began digitizing 65-thousand patient charts at its busy Philadelphia practice.

Now Dr. George Valko uses electronic records to check lab results or send prescriptions to the pharmacy. When he opens Michael Hamilton’s file, images from Hamilton’s latest MRI are there, too.

Dr. George Valko is leading the digital conversion at Jefferson Family Medicine.Valko: This is your hip bone that goes into the socket. Nice and smooth, looking good. Look at this hip bone, it’s all destroyed.

Hamilton probably needs a hip replacement. He knows an orthopedic surgeon that he trusts at Cooper University Hospital, so Dr. Valko is handing off the case.

Valko: We now have the ability to interact with each other within the Jefferson community, but we can’t interact with our colleagues say at University of Pennsylvania, Temple, Cooper, across the river in a meaningful way.

Valko says, in a few years every patient at Jefferson will have a Web-based, password protected medical records site, patients could book appointments or share health information with whoever they want, from where ever they are. For now, though, here’s how Valko will get Hamilton’s records to the specialist at Cooper.

Valko: I will print them out and give them the old fashioned way, and give them to Michael.

E-records might help prevent medication errors and remind doctors to prescribe life-saving screening tests. But a 2005 study from the Harvard Medical School suggests many doctors are not fully using their health technology. Lead researcher Jeffrey Linder found no link between using e-records and improved quality of care.

Linder: Making the point that electronic health records aren’t magic, you can’t sort of turn them on, and expect medical quality to magically get better.

Linder’s a general internist at Boston’s Brigham and Women’s Hospital. In his practice, digital records have become an invaluable tool for patient education. Linder says he thinks that leads to better health.

Most doctors still rely on paper to exchange health information with specialists and physicians outside of their own practice.Linder: I frequently find myself spinning the computer monitor around and looking over it with the patient, to look at people’s blood pressure over time, or cholesterol over time.

Another study backs up George Valko’s observation that many doctors still exchange information the old-fashioned, hard-copy way. Physician-researcher Ann O’Malley led the survey for the Center for Studying Health System Change.

O’Malley: The electronic medical records in one office don’t talk to the electronic medical records in the other office.

In O’Malley’s survey some doctors said they didn’t fully know how to use their e-record systems, while others reported that their technology was too clunky to extract information for a whole population of patients.

O’Malley: It’s very hard for that primary care doctor to go through their entire panel of women over 50 and see who’s had a mammogram and who hasn’t, or to see, of those who’ve had a mammogram which ones are normal versus abnormal, they just can’t manipulate the data.

So, a big gap remains between how physicians really use e-records – and the hope that technology will revolutionize care. George Valko says many systems fall short for the patient with diabetes or high blood pressure who hasn’t had a check up in awhile.

Valko: Even your car dealer will send you a reminder that your car is due for an inspection, or something like that.

Only about 15 percent of medical groups use e-records and many of them are elite, large practices. Next year, Medicare will begin rewarding physicians who prove they’re using e-records wisely to improve care. Each doctor could collect up to $44,000 in bonuses over five years. But Harvard’s Jeffrey Linder says those rewards may not be enough.

Linder: The brunt of the cost of putting in an electronic health record falls on the provider, and some providers may decide that they are just not enough to off set the cost of putting in an electronic health record.

Linder says small- and rural practices need more help with the upfront cost of installing new technology. Without that, the digital divide may widen and the hopes for e-records may fizzle.